Reflux ya matenda opatsirana pogonana: zizindikiro, matenda, ndi mankhwala

M'chaka cha 1879, dokotala wina wa ku Germany, dokotala wa opaleshoni ndi wasayansi, dzina lake Heinrich Quinke, anafotokoza mmene zimachitika m'thupi mwa anthu akamadya, ndipo amatcha reflux ya gastroesophageal (kuchepetsa GER). Mawu ofanana ndi mawu ovuta-akuti-kutchulidwa ndi reflux ya gastroesophageal. Mawu akuti "reflux" m'Chilatini amatanthawuza "kubwerera mmbuyo", ndipo mu mankhwala mawu awa amatanthauza kusunthira mmbuyo poyerekeza ndi kayendetsedwe kayendedwe ka zomwe zili mu ziwalo zilizonse zopanda kanthu. Ngati mwapezeka ndi izi, simukuyenera kukwiya, chifukwa GER ngokha si matenda ndipo safuna mankhwala. Koma nthawi zina njira zokhudzana ndi thupi zimalephera, chakudya chomwe chimabwerera kuchokera m'mimba kupita kummimba, chimayamba kudya maselo ake omwe amatha kupweteka, ndipo munthuyo amakumana ndi zovuta nthawi yomweyo. Pazochitikazi, matendawa amasonyeza reflux ya gastroesophageal ndi esophagitis - matenda oopsa omwe angapangitse khansa yowopsya.

Njira ya reflux ya gastroesophageal

Kuchokera paziphunzitso za thupi, timadziwa kuti chakudya chophwanyika pakamwa pamene chimameza chimalowetsa m'mimba, chomwe chimakhala chiguduli. Ntchito zake zimangoperekedwa mofulumira kwa mtanda wa chakudya m'mimba, kumene amayamba kukumbidwa. Kutalika kwake kwa anthu ambiri ndi masentimita 30. M'mbali ya pansi, minofu ya mitsempha yake imakonzedwa kuti ikhale ngati valve (sphincter). Mukasuntha mtanda wa chakudya, amamasuka, amawapititsa m'mimba, ndiyeno amawongolera, kuteteza kutuluka kwa chakudya kubwerera m'mimba. Ngati ndimeyi siitetezedwe mokwanira, zomwe zili m'mimba (chakudya ndi msuzi wa m'mimba) zimasunthira pang'ono pamutu, ndiko kuti, reflux ya gastroesophageal imachitika. Zizindikiro ndi chithandizo cha matendawa zimadalira momwe njira zowatetezera zimagwirira ntchito pambali. Kwa anthu ambiri, izi sizimayambitsa chisokonezo kapena zopweteka, choncho sizikusowa chithandizo. Komabe, nthawi zina kubwerera kwa gawo la chakudya kuchokera mmimba kupita kumimba kumaphatikizapo zowawa kapena zosautsa chabe. Pazochitikazi, kufunsa ndi kuchipatala kwa dokotala n'kofunika.

Mmene Njira Zoteteza Zimagwirira Ntchito

Chifukwa chiyani nthawi zina sizowononga chakudya cha gastro, ndi zina zoopsa? Zoona zake n'zakuti munthu amayambitsa "chilengedwe" mwachilengedwe kuti azilankhulana ndi alangizi a zamchere okhaokha, omwe amawotcha chakudya chochokera mmenemo. Mimba sikuti imangotenga chakudya, imayamba kukumba, yomwe imapanga madzi ammimba - madzi kuchokera ku mapangidwe a michere, ntchentche ndi chimagulu - hydrochloric acid. Kamodzi kake, imayamba "kukumba" maselo achilendo a mpanda wake mofanana ndi zidutswa za chakudya. Ngati munthu ali ndi njira zotetezera zachilengedwe zosautsa, reflux ya chakudya siipa kwa iwo. Njira zoterezi ndi izi:

- mokwanira mokweza mawu a esophageal sphincter, omwe salola kuti chakudya chiziyenda kupitirira gastroesophageal zone;

- kuyenera bwino (kuyeretsa mofulumira kwa mimba kuchokera kumalo opezeka m'mimba);

- Kukhazikika kwa maselo osakanikirana omwe amatha kupwetekedwa ndi hydrochloric acid;

- kulamulira kwa acidity wa mimba yamimba.

Zizindikiro za GER zomwe si matenda

Tiyeni tikambirane pamene reflux ya zakudya zowonongeka zingatengedwe ngati chizoloŵezi cha thupi laumunthu. Zizindikiro zowonongeka kotereku m'thupi:

- munthu samva chisoni chilichonse (ichi ndi chimodzi mwa zizindikiro zazikulu);

- Kuponyera chakudya m'mimba kuchokera kumimba kumawonetsedwa pokhapokha mutatha kudya;

- reflux imatenga kanthawi kochepa ndipo imachitika kangapo patsiku;

- usiku akamagona, reflux sizimachitika.

Tiyenera kukumbukira kuti kutaya thupi kwa chakudya kuchokera m'mimba kupita kumimba kumapezeka mwa anthu a msinkhu uliwonse, kuphatikizapo ana.

Kupewa GER wopanda vuto

Ngakhale pamene vuto la reflux la gastroesophageal si vuto, mukhoza kutenga njira zingapo zosavuta kuthandiza GIT yanu. Kuchepetsa kuwonetsa kwa reflux kungathe kuchita zosavuta:

- musagone mwamsanga mukatha kudya;

- musayambe ntchito yamagetsi, makamaka yokhudzana ndi malo otsetsereka, osadyeka kudya;

- Musadye mopitirira;

- kuchepetsa kugwiritsiridwa ntchito kwa mankhwala (chokoleti, mowa, mankhwala enaake), kusangalatsa sphincter wa mimba;

- musayambe kudya molimba kwambiri, ndi lamba wolimba;

- kuchepetsa kuchuluka kwa mautumiki, ndikuwonjezera kuchuluka kwa chakudya.

Zizindikiro za GER, ndiyo matenda

Matendawa ndi reflux ya gastroesophageal ndi esophagitis. Zimakhalapo pamene njira zotetezera za m'mimbazi zikulephera ndipo sitingathenso kuteteza maselo achilendo kuti asawononge hydrochloric acid. Matendawa ali ndi mitundu iwiri ya zizindikiro.

1. Esophageal. Odwalawo amamva zovuta zoterezi:

- kupweteka kwa mtima;

- kulawa kowawa pakamwa;

- zovuta (makamaka zowawa);

- dysphagia (kudya kotheka perephivaniya);

- kupweteka kumbuyo kwa sternum (kawirikawiri kumawonjezeka ndi tilts ndi kugona pansi, kumatha kupitirira mikono ndi khosi).

2. Osagwiritsidwa ntchito. Odwala angakhale ndi zizindikiro zotsatirazi:

- mavuto a mano (caries, zolakwika za enamel);

- sinusitis;

- laryngitis;

- pharyngitis;

- Kudula;

Ululu mu mtima.

Chifukwa cha mawonetseredwe awa, ma GER amapezeka kuti ndi olakwika ndipo amachititsa anthu ku matenda omwe salipo.

Zimayambitsa

Reflux yamatenda a m'mimba amatha kupezeka pazifukwa zotsatirazi:

- kunenepa kwambiri;

- Mowa, kusuta;

- hernia wa kutsegulira osungunuka;

Zakudya zopanda thanzi;

- mankhwala omwe amachepetsa mawu a sphincter;

- Kusanza kwakukulu (kumachitika poizoni);

- systemic scleroderma;

- nasogastric chubu.

Matenda otsekula m'mimba mwa ana

M'masiku oyambirira ndi miyezi ya moyo, pafupifupi ana makumi asanu ndi atatu (80%) amawonedwa akubwezeretsedwa atatha kudya. Kaŵirikaŵiri, kugwidwa kwa gastroesophageal ya mwana si matenda ndipo kumabwera chifukwa cha kupanda ungwiro kwa dongosolo la GIT. Komanso, kubwezeretsa kumateteza mwanayo kuti asadye komanso kusungira mimba m'mimba mwake. Makolo akhoza kungogwira pamtunda kwa mphindi 10 mutatha kudya, kotero kuti kubwezeretsa sikuchitika. Mavuto aakulu ndi mmimba ndi m'mimba amatsimikiziridwa ndi zizindikiro zotere:

- kulira kosalekeza ndi nkhawa za mwanayo;

- kumangirira;

- kusanza (osati kusokonezeka ndi regurgitation) mutatha kudya;

- kukana kudya;

- chisa;

- chifuwa chopanda pake;

- Mwana sakugona bwino ndipo sakulemera.

Malinga ndi umboniwo, dokotala akhoza kupereka malangizo kwa makoswe a ana omwe amamwa mowa ndi mankhwala "Cisapride", "Domperidon", "Metoclopramide", "Cimetidine". Ngati reflux imayambitsa matenda mu kapangidwe ka kapangidwe kakang'ono, opaleshoni njira ndizotheka.

Kutentha kwapadera kwa ana oposa zaka 1

Kwa ana ambiri, mwa miyezi 12-18 yowonjezereka pakudya pambuyo pake, zimatha. Ana amakula ali ndi thanzi labwino ndipo samakhala osasangalala akamadya. Koma ana ena ali ndi zodandaula zina zomwe zimasonyeza mavuto m'mimba kapena m'mimba:

- kupweteketsa mtima (mwanayo amafotokoza chizindikiro ichi monga "moto" kapena "moto");

- kupweteka;

Ululu mu sternum;

- kunyoza;

- kumverera kwa raspiraniya mmimba;

- Kubwereranso usiku pamene tulo (izi zikhoza kuwonedweratu pamapazi pa pillow).

Kawirikawiri kumayambiriro kwa reflux gastroesophageal kwa ana ndi zizindikiro zosagwirizana kwathunthu ndi digestive dongosolo:

- chifuwa;

- mawu ofunika;

- mtanda ndi pakhosi;

- kupuma kwakukulu;

- Kupuma pang'ono;

Zovuta pakumeza;

- chibayo chafupipafupi.

Kawirikawiri, zizindikiro izi zimayamba kuchiza chimfine, koma ndi GER chithandizo chotero sichipereka zotsatira.

Zofufuza

Ngati wodwalayo ali ndi zizindikiro zosasangalatsa kapena zopweteka za matenda a reflux a gastroesophageal, ayenera kugwiritsidwa ntchito pogwiritsa ntchito njira zamakono zamakono komanso zamagetsi. Pa gawo loyamba, gastroenterologist imasonkhanitsa an anamnesis yomwe imaphatikizapo chidziwitso chonena za matenda ngati achibale awo, nthawi ndi mphamvu za zizindikiro za reflux. Gawo lachiwiri ndikuchita maphunziro a labotale, monga:

- kuyezetsa magazi (biochemical ndi general);

- pulogalamu;

Kusinkhasinkha kwa mkuyu.

Gawo lachitatu la matendawa limaphatikizapo maphunziro:

- manometry ya phokoso;

- EGDS (esophagogastroduodenoscopy);

- kuyesa kosokoneza;

- Mafilimu akugwiritsa ntchito kuyimitsidwa kwa barium;

- Ultrasound.

Chithandizo

Ngati reflux ya gastroesophageal imapezeka, mankhwalawa amachitidwa m'njira zitatu:

1. Osati mankhwala. Zimaphatikizapo zinthu zotsatirazi:

- kukonza kulemera;

- Zakudya (osati chokoleti, mowa, mafuta, zokometsera, khofi, adyo, zipatso);

- kukonza chakudya;

- Kutulutsidwa kuchokera ku chovala cha zovala zolimba, mikanda yopapatiza;

- kukweza mutu wa bedi ndi masentimita 20.

2. Mankhwala:

-kuyimitsa mankhwala a proton (kuchepetsa kumasulidwa m'mimba mwa hydrochloric acid, "Rapeprazole", "Omeprazole");

- antacids (mankhwalawa amachititsa kuti asiye hydrochloric acid "Fosfalugel", "Almagel");

- prokinetics (kuyendetsa kayendetsedwe ka chakudya kuchokera m'mimba mpaka m'mimba "Metoclopramide").

3. Opaleshoni. Zimagwiritsidwa ntchito ngati mitundu iwiri yapitayi siipereka kusintha kooneka.

Ngati matendawa sali ochiritsidwa, hydrochloric acid yomwe imalowetsa m'mimba imatha kuyambitsa zilonda zake, kuthamanga kwa magazi, kutuluka kwa magazi, zomwe zimatchedwa kuti Barrett, zomwe zimapangitsa kuti chiwopsezo chachikulu chiyambike.